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Going for gold

Going for gold

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The National Institute for Health and Clinical Excellence (NICE) quality standards were launched by the then Secretary of State for Health, Andrew Lansley, in June 2010. NICE has just published its 25th quality standard (asthma) and there are a further 24 healthcare standards currently in development, due to be published this year. 

From April 2013, NICE will also begin producing quality standards for social care services. Topics that have already been referred to NICE include autism (in both children and adults) and the transition between health and social care services. Two quality standards, which focus on the care of people with dementia and the health and wellbeing of looked-after children, are both set to publish in April.

Quality standards are a set of concise, prioritised statements and associated measures that focus on topics relevant to health and/or social care. Each standard is derived either from NICE guidance or NICE accredited sources and produced collaboratively with the NHS or public health organisations, along with their partner organisations, patients, carers and service users.

NICE quality standards do not provide a comprehensive service specification. They define priority areas for quality improvement based on consideration of the topic area. They are a final distillation of accredited guidance from NICE and other organisations, and are intended to provide a clear description (in around six to eight statements) of what a high quality service would look like. They enable organisations to move towards improving quality and delivering excellence. 

The standards at present apply to England only. It will be for the UK devolved administrations to decide on local policy. Where appropriate, service level agreements will be put in place.

There are two components to a NICE quality standard:

First, the six to eight quality statements (with up to a maximum of 15 in exceptional circumstances) describe the key infrastructural and clinical requirements for high quality care and improvement. They are aspirational but achievable. Each statement is accompanied by a description of its implications for different audiences (service providers, health and social care professionals, public health practitioners, commissioners, patients, service users and carers); the guidance used as an evidence source; the sources of data that can be used for measurement, definitions of the terms used and, where relevant, equality and diversity considerations.

Secondly, quality measures are high-level quality indicators and aim to assess the quality of care or service provision specified in the statement.

Quality standard topics are formally referred to NICE by NHS England, for health-related areas, and by the Department of Health and Department for Education for non-health areas such as social care. 

The long-term aim is for all health and social care teams to have access to a relevant quality standard.

In addition to producing quality standards focusing on the care pathway for people with specific medical conditions, 

NICE is beginning to develop quality standards on issues such as service delivery and co-morbidities.

Who are quality standards for?

Commissioners

Health care professionals 

Social care professionals

Public health professionals 

Patients, service users and the public 

Carers

Service providers 

Commissioners should set thresholds against NICE quality standards, as suggested by the Francis report, to be monitored during the commissioning process by routine indicators and audit tools provided by NICE. 

Stakeholders are provided with advance notice of the topic development schedule and consultation phase of each quality standard. They are also kept updated throughout the development process and are notified by email and on the NICE website about opportunities to contribute to the development of a standard (during the topic engagement exercise and when a draft quality standard is available for consultation). Stakeholders are invited to submit comments on a pro-forma using a dedicated email address. 

These evidence-based standards will be crucial for patients, service users and the public to know what level of care to expect, and for providers of health and social care to know what works to be able to deliver excellent, clinically and cost-effective care. Patient, service user and public expectations will also help drive up standards in care. NICE quality standards are a major step forward in quality improvement, and it is an important opportunity for the NHS and health and social care and public health providers to come together in their implementation. 

At present they are not mandatory and the NHS and social care sector is not obliged to use them. However, the Health and Social Care Act (2012) makes it clear that the Secretary of State, in discharging his/her duty to improvement in quality of health services, “must have regard to the quality standards prepared by NICE.”

NICE recognises that quality standards are being published at a time of considerable change in the NHS. We are also fully aware of the need for the NHS to make substantial efficiency savings in the coming years. 

We believe the standards can play an important part in helping NHS organisations to achieve the best outcomes, and we have been careful to avoid adding significant additional costs in the practice we are recommending. 

These quality standards represent what works and what is cost-effective in the NHS, so if used they have the potential to deliver savings for the NHS. 

A support document for commissioners and others is developed and published alongside the quality standards in order to assist commissioners and service providers to consider the commissioning implications and potential resource impact of using NICE quality standards. This is crucial in this time of financial austerity in the NHS. 

Quality standards will improve the quality of care being provided in the NHS and social care, if they are supported at national, regional and local levels. There is potential for them to deliver real change in quality and to meet to the rising expectations of patients, service users and the public. l

Further information visit the NICE website

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